in review

I’m going to try not to comment on this too frequently, as I get to operate more. But:

I had a case the other night. I did most of it myself. Being as objective as I can manage, I think I did not do it too badly, perhaps even very well at some points, but overall I was certainly slower than the attending doing it all himself would have been.

Now, a few days later, the patient is struggling through the post-op period. Nothing frankly technical (no vascular bleeding, or suture lines falling apart) – but I can’t stop going over the case again and again, trying to decide, definitely, whether if I had tied those knots faster, or run that suture line more adeptly, or not crossed that one tissue plane that we weren’t supposed to cross, would he be doing appreciably better now? Or was he just a sick man having a high-risk operation, and the current problems are no more than were bound to result anyway? Really, actually, I think I probably only added 15 minutes to a 4 hour case. But I operated on him; I cut on him – and now he’s sick. . .

This is scenario is replayed for every one of my patients who encounters what, last year, not operating, I would have regarded as a common and inevitable post-op complication; a bump in the road. But now, I touched the patient; I more than touched them; I was cutting things up; and now things are not perfect.

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5 Responses to “in review”

C’mon Alice…
Its Anesthesia’s fault…
Did they use Nitrous? Propofol, Etomidate? Pentothal? One of the “Ane” gases??? And don’t even get me goin about Spinals & Epidurals…
I thought they taught you Surgeons that on day 1…

I get this way all the time… I may or may not have checked wound drains obsessively to make sure they’re not filling up with blood courtesy of my suture line coming undone! I recently had a lady who died a few days post-op a ‘routine’ procedure – as it turned out, she unfortunately had an unrecognised completely unrelated condition. But I have heard that it’s all my fault talk in my head before. It hurts. It hurts a lot!

We’re only human us surgeons. There is a very real chance that someone’s misfortune will result from our mistake. But in the meantime, you just have to be the best you can be and try to learn how not to make mistakes. Sure you did a great job. Some patients are just very sick and get complications.

And yeah if that doesn’t make you feel better, like Frank says, blame anaesthesia :)

We are humans who are gifted at specific skills, yours has always been with your hands. I’m gratified you didn’t say it was the Nurse’s fault, after all, they are on the front line of care. I’m delighted you didn’t pull a Job’s wife response. You are doing a great job and you need to celebrate your successes. It’s not your fault, and you know you would say the same to a colleague.

I think you’re being overly dramatic about this. There is always going to be a margin of error in every case. The important part is to take responsibility for your actions. My brother once came out if a surgery worse than when he went in. The doctor (eventually) admitted his mistake and went to every effort to rectify it. Now my brother is better than ever. What I’m trying to say is that humans are resilient creatures and your patient is going to be fine in the long run. They will be grateful that you helped them avoid death because, as Roosterteeth said, “It is … a fundamental quality of man that when faced with extinction, every alternative is preferable.”